NUR209 / NUR 209 Medical Surgical Nursing II Exam 2
ACTUAL PRACTICE EXAM 2026/2027 | Verified
Questions and Answers | Aligned to Fortis Curriculum &
NCLEX Style | Grade A Target | Pass Guaranteed
Section 1: Endocrine Disorders (15 Questions)
Q1: A 24-year-old client with Type 1 diabetes mellitus is admitted with fruity breath, Kussmaul
respirations, and a blood glucose of 480 mg/dL. The client is lethargic but arousable. Which
nursing intervention is the priority?
A. Administer regular insulin IV per protocol
B. Initiate IV fluid resuscitation with 0.9% NaCl
C. Obtain a 12-lead ECG immediately
D. Insert a Foley catheter for strict I&O monitoring
Correct Answer: B
Rationale: In diabetic ketoacidosis (DKA), the priority intervention is fluid resuscitation. Severe
dehydration occurs due to osmotic diuresis, and correcting volume depletion improves
perfusion and insulin sensitivity. While insulin administration (A) is critical, fluid replacement
must precede or accompany it to prevent hemodynamic collapse. According to the ADA
Standards of Care, initial fluid therapy with isotonic saline restores intravascular volume and
supports renal perfusion before insulin drives glucose and potassium intracellularly. The ECG (C)
is important for monitoring potassium shifts but is not the immediate priority. Foley
catheterization (D) is useful for monitoring but is secondary to life-saving fluid resuscitation.
Q2: A 58-year-old client with Type 2 diabetes is prescribed metformin 1000 mg BID and glipizide
10 mg daily. The client asks the nurse why both medications are needed. Which response by the
nurse is most accurate?
A. "Metformin helps your pancreas make more insulin, while glipizide helps your body use
insulin better."
B. "Both medications work to decrease the amount of sugar your liver produces."
C. "Metformin decreases hepatic glucose production and improves insulin sensitivity, while
,glipizide stimulates pancreatic beta cells to release insulin." [CORRECT]
D. "Glipizide is for fasting blood sugar control, and metformin is for post-meal control only."
Correct Answer: C
Rationale: Metformin is a biguanide that primarily suppresses hepatic gluconeogenesis and
improves peripheral insulin sensitivity without causing hypoglycemia. Glipizide is a sulfonylurea
that stimulates pancreatic beta-cell insulin secretion. This combination addresses insulin
resistance and relative insulin deficiency in Type 2 diabetes. Option A reverses the mechanisms.
Option B is incorrect because glipizide does not affect hepatic glucose production. Option D is
inaccurate as both medications affect overall glycemic control, not just specific times of day.
Q3: A client with Graves' disease is started on methimazole. Which instruction is essential for
the nurse to include in the teaching plan? (Select all that apply)
A. Report sore throat or fever immediately
B. Take the medication with food to reduce GI upset
C. Expect improvement in symptoms within 2-3 days
D. Avoid foods high in iodine
E. Have regular CBC monitoring scheduled
Correct Answers: A, B, D, E
Rationale:
• A is correct: Agranulocytosis is a rare but life-threatening adverse effect of antithyroid
medications. The client must report signs of infection (sore throat, fever) immediately
for CBC evaluation.
• B is correct: Methimazole can cause nausea and GI distress; taking with food improves
tolerance.
• C is incorrect: Symptom improvement typically takes 2-4 weeks as hormone stores
deplete, not 2-3 days. Beta-blockers provide immediate symptom relief.
• D is correct: Iodine is substrate for thyroid hormone synthesis; restricting iodine
(seafood, iodized salt) supports treatment effectiveness.
• E is correct: Baseline and periodic CBC monitoring is essential to detect bone marrow
suppression.
, Q4: A client with Addison's disease presents to the ED with confusion, hypotension (82/48
mmHg), and hyperkalemia (K+ 6.2 mEq/L). The nurse suspects adrenal crisis. Which medication
should the nurse prepare to administer first?
A. Hydrocortisone 100 mg IV push
B. Fludrocortisone 0.1 mg PO
C. Potassium-binding resin enema
D. Regular insulin with dextrose IV
Correct Answer: A
Rationale: Adrenal crisis is a life-threatening deficiency of cortisol and aldosterone. The
immediate priority is IV hydrocortisone, which provides both glucocorticoid and
mineralocorticoid effects, restoring vascular tone, improving cardiac contractility, and
preventing shock. Fludrocortisone (B) is for chronic mineralocorticoid replacement only and
takes hours to days for effect. While hyperkalemia (C, D) is dangerous, it will correct with fluid
resuscitation and cortisol replacement, which drive potassium intracellularly. Cortisol
administration is the definitive treatment for the underlying crisis.
Q5: A client with Cushing's syndrome is being prepared for a bilateral adrenalectomy. Which
preoperative nursing intervention demonstrates best understanding of the pathophysiology?
A. Administering glucocorticoids before surgery and continuing postoperatively
B. Restricting sodium intake to prevent fluid overload
C. Monitoring for signs of hyperglycemia and providing sliding scale insulin
D. All of the above [CORRECT]
Correct Answer: D
Rationale: Cushing's syndrome involves chronic cortisol excess, causing hypertension,
hyperglycemia, and immunosuppression. Preoperative glucocorticoids (A) are essential because
removal of adrenal glands eliminates all cortisol production, risking acute adrenal insufficiency.
Sodium restriction (B) addresses mineralocorticoid effects of cortisol (fluid retention,
hypertension). Hyperglycemia monitoring (C) is necessary as cortisol induces insulin resistance.
All interventions address critical preoperative considerations for this high-risk surgery.
Q6: A nurse is caring for four clients on the medical-surgical unit. Which client should the nurse
assess first?
A. A client with Type 2 diabetes and a blood glucose of 245 mg/dL who is due for insulin
B. A client with hypothyroidism who reports feeling "more tired than usual"
ACTUAL PRACTICE EXAM 2026/2027 | Verified
Questions and Answers | Aligned to Fortis Curriculum &
NCLEX Style | Grade A Target | Pass Guaranteed
Section 1: Endocrine Disorders (15 Questions)
Q1: A 24-year-old client with Type 1 diabetes mellitus is admitted with fruity breath, Kussmaul
respirations, and a blood glucose of 480 mg/dL. The client is lethargic but arousable. Which
nursing intervention is the priority?
A. Administer regular insulin IV per protocol
B. Initiate IV fluid resuscitation with 0.9% NaCl
C. Obtain a 12-lead ECG immediately
D. Insert a Foley catheter for strict I&O monitoring
Correct Answer: B
Rationale: In diabetic ketoacidosis (DKA), the priority intervention is fluid resuscitation. Severe
dehydration occurs due to osmotic diuresis, and correcting volume depletion improves
perfusion and insulin sensitivity. While insulin administration (A) is critical, fluid replacement
must precede or accompany it to prevent hemodynamic collapse. According to the ADA
Standards of Care, initial fluid therapy with isotonic saline restores intravascular volume and
supports renal perfusion before insulin drives glucose and potassium intracellularly. The ECG (C)
is important for monitoring potassium shifts but is not the immediate priority. Foley
catheterization (D) is useful for monitoring but is secondary to life-saving fluid resuscitation.
Q2: A 58-year-old client with Type 2 diabetes is prescribed metformin 1000 mg BID and glipizide
10 mg daily. The client asks the nurse why both medications are needed. Which response by the
nurse is most accurate?
A. "Metformin helps your pancreas make more insulin, while glipizide helps your body use
insulin better."
B. "Both medications work to decrease the amount of sugar your liver produces."
C. "Metformin decreases hepatic glucose production and improves insulin sensitivity, while
,glipizide stimulates pancreatic beta cells to release insulin." [CORRECT]
D. "Glipizide is for fasting blood sugar control, and metformin is for post-meal control only."
Correct Answer: C
Rationale: Metformin is a biguanide that primarily suppresses hepatic gluconeogenesis and
improves peripheral insulin sensitivity without causing hypoglycemia. Glipizide is a sulfonylurea
that stimulates pancreatic beta-cell insulin secretion. This combination addresses insulin
resistance and relative insulin deficiency in Type 2 diabetes. Option A reverses the mechanisms.
Option B is incorrect because glipizide does not affect hepatic glucose production. Option D is
inaccurate as both medications affect overall glycemic control, not just specific times of day.
Q3: A client with Graves' disease is started on methimazole. Which instruction is essential for
the nurse to include in the teaching plan? (Select all that apply)
A. Report sore throat or fever immediately
B. Take the medication with food to reduce GI upset
C. Expect improvement in symptoms within 2-3 days
D. Avoid foods high in iodine
E. Have regular CBC monitoring scheduled
Correct Answers: A, B, D, E
Rationale:
• A is correct: Agranulocytosis is a rare but life-threatening adverse effect of antithyroid
medications. The client must report signs of infection (sore throat, fever) immediately
for CBC evaluation.
• B is correct: Methimazole can cause nausea and GI distress; taking with food improves
tolerance.
• C is incorrect: Symptom improvement typically takes 2-4 weeks as hormone stores
deplete, not 2-3 days. Beta-blockers provide immediate symptom relief.
• D is correct: Iodine is substrate for thyroid hormone synthesis; restricting iodine
(seafood, iodized salt) supports treatment effectiveness.
• E is correct: Baseline and periodic CBC monitoring is essential to detect bone marrow
suppression.
, Q4: A client with Addison's disease presents to the ED with confusion, hypotension (82/48
mmHg), and hyperkalemia (K+ 6.2 mEq/L). The nurse suspects adrenal crisis. Which medication
should the nurse prepare to administer first?
A. Hydrocortisone 100 mg IV push
B. Fludrocortisone 0.1 mg PO
C. Potassium-binding resin enema
D. Regular insulin with dextrose IV
Correct Answer: A
Rationale: Adrenal crisis is a life-threatening deficiency of cortisol and aldosterone. The
immediate priority is IV hydrocortisone, which provides both glucocorticoid and
mineralocorticoid effects, restoring vascular tone, improving cardiac contractility, and
preventing shock. Fludrocortisone (B) is for chronic mineralocorticoid replacement only and
takes hours to days for effect. While hyperkalemia (C, D) is dangerous, it will correct with fluid
resuscitation and cortisol replacement, which drive potassium intracellularly. Cortisol
administration is the definitive treatment for the underlying crisis.
Q5: A client with Cushing's syndrome is being prepared for a bilateral adrenalectomy. Which
preoperative nursing intervention demonstrates best understanding of the pathophysiology?
A. Administering glucocorticoids before surgery and continuing postoperatively
B. Restricting sodium intake to prevent fluid overload
C. Monitoring for signs of hyperglycemia and providing sliding scale insulin
D. All of the above [CORRECT]
Correct Answer: D
Rationale: Cushing's syndrome involves chronic cortisol excess, causing hypertension,
hyperglycemia, and immunosuppression. Preoperative glucocorticoids (A) are essential because
removal of adrenal glands eliminates all cortisol production, risking acute adrenal insufficiency.
Sodium restriction (B) addresses mineralocorticoid effects of cortisol (fluid retention,
hypertension). Hyperglycemia monitoring (C) is necessary as cortisol induces insulin resistance.
All interventions address critical preoperative considerations for this high-risk surgery.
Q6: A nurse is caring for four clients on the medical-surgical unit. Which client should the nurse
assess first?
A. A client with Type 2 diabetes and a blood glucose of 245 mg/dL who is due for insulin
B. A client with hypothyroidism who reports feeling "more tired than usual"
